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Huge Disparity in Health System Transparency around the World: KPMG Study

Huge Disparity in Health System Transparency

Head of External Communications, Intelligent Automation, Alliances and Customer

KPMG International

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Through the looking glass: a practical path to improving healthcare through transparency places four Nordic nations – Denmark, Finland, Sweden and Norway – at the top of the transparency rankings, with Australia, Netherlands, New Zealand, UK, Portugal and Singapore among the second tier, and China and India propping up the index. KPMG rated nations’ healthcare systems on the availability of data across six dimensions of transparency, including quality care, financial performance and governance.

Even the high performers lack consistency across all forms of transparency, with much room for improvement. “These findings show that health systems are struggling to make the most of transparency,” said Mark Britnell, Chairman of KPMG’s Global Health Practice and a partner with KPMG in the UK. “Our global index reveals a patchwork of efforts that often lack strategic coherence.”

The study also highlights big variations across several dimensions of transparency. ‘Governance’ and ‘Finance’ indicators scored the highest across six dimensions, while data on ‘Quality of Healthcare’ was the lowest – suggesting this is the area where health systems are most cautious to release data.

“There is no consensus on what transparency in healthcare looks like,” KPMG’s Britnell continued. “We see a wide range of interpretations based on country, care setting and stakeholder group, which reflects a lack of strategic clarity about what it is for and how to use it as an improvement tool. It’s time that it was seen less as political force and more as a tool to improve healthcare – albeit one that can have negative effects if used ineptly.”

Transparency: a force for good…and for ill

KPMG’s global study found plenty of good examples of transparency in practice, with evidence that public reporting stimulates quality improvement activities, especially at the hospital level. Publishing performance data, however, produces mixed results, in some cases leading to improved health outcomes, and in other instances resulting in negligible or potentially worse outcomes. The practice of ‘naming-and-shaming’ is particularly contentious, with many practitioners concerned that it is demotivating and divisive.

“Our conversations with healthcare professionals also show that unreliable data is a major problem,” said Marc Scher, Chair of KPMG’s healthcare transparency study and a partner with KPMG in the US. “Publishing data about a health system is not helpful – and can even be harmful – if that data is incomplete, inaccurate, out-of-date, or not comparable. The wrong conclusions can be drawn and inappropriate actions taken, which generates further resistance to transparency, because physicians fear they will be unfairly labelled.”

The sheer volume of data can also prove quite a distraction, with the range of metrics expanding to a point where significant amounts of resources and money are devoted to collecting and analyzing numbers that are never really used. “Some hospitals we looked at are delivering as many as a thousand performance indicators,” said Scher. “Not only are these frequently of poor quality, but it’s almost impossible to highlight the data that is really important to clinical improvement. If current trends continue, health systems could be overwhelmed by data requirements that distract from the real business of healthcare improvement.”

Imagining a brighter future for healthcare transparency

Transparency may not have delivered on its promise, but that doesn’t mean it’s going away. As the report emphasizes, the trend towards greater transparency is inevitable, given the explosion in the amount of healthcare data and rising consumer expectations of patients and the public.

KPMG’s Britnell said that, to realize the full value of this trend, a ‘whole-system’ approach is needed. “If health systems want transparency to fulfil its promise to improve quality, they need a more disciplined, long-term approach. This means measuring what really matters, taking a selective, phased approach to data publication, learning from other innovative providers and promoting high trust cultures.”

For information, contact:

Jennifer Samuel KPMG International +1 416 777 8491 Jsamuel@kpmg.ca

About the paper

Through the looking glass: a practical path to improving healthcare through transparency is a global study that examines how health systems are approaching transparency, and what they can do to maximize the benefits from this powerful, positive change agent. The study also explores what makes a health system transparent, and imagines an optimum future for transparency – and how to achieve this. The study is the result of 25 interviews with a variety of global healthcare experts, 16 global case studies from countries like Australia, Denmark, Germany, the Netherlands, UK and US, an extensive literature review, plus a transparency scorecard completed by leaders of KPMG’s health practices in 32 countries, which informs an index of performance across six key dimensions of transparency (see full Index results).

About KPMG’s Global Healthcare team

With deep industry experience, insight and technical support, KPMG firms are among the leaders in delivering a broad range of audit, tax and advisory services to meet the unique needs of healthcare policy-makers, providers and payers. With in-depth knowledge and experience in the business sectors in which they operate. KPMG member firms bring together expertise in key segments across healthcare – enabling our professionals to deliver an informed perspective on market challenges and opportunities from one sector to another and to share best practices and leading thinking.

About KPMG International

KPMG is a global network of professional services firms providing Audit, Tax and Advisory services. We operate in 152 countries and have 189,000 people working in member firms around the world. The independent member firms of the KPMG network are affiliated with KPMG International Cooperative ("KPMG International"), a Swiss entity. Each KPMG firm is a legally distinct and separate entity and describes itself as such.